Cedar House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service assessed and reviewed people’s care, health and communication needs but did not always use assessments and reviews to reflect the changing care needs of each person. For example, the service had not updated assessments of a person’s care to consider their changing needs for support to be safe from the risk of choking. Other assessments considered people’s holistic needs, such as their likes and dislikes, people who were important to them, religion and culture and life story, as well as their physical care needs. The information was detailed and personalised. People’s care plans gave information and guidance on how to communicate with them while providing care, such as by using objects of reference to let a person know what was going to happen. For example, by handing a person shampoo to smell when having their hair washed. This included how a person expressed pain so staff could recognise and respond to this. People’s relatives or advocates were involved in assessing their care needs and reviewing their care plans.

The provider did not always consistently plan people’s care and treatment with them and others so as to always meet their care needs. For example, care records showed a person experienced re-occurring issues with their catheter but there was not clear guidance in their care plan on how to provide safe catheter care to minimise this. People’s care plans set out their dietary needs, preferences and allergies and staff were aware of these. There were guidelines in place to help some people to eat and drink safely. The service liaised with professionals, such as dietitians and speech and language therapists, to develop these guidelines. Staff supported people with their food and drink needs in line with their care plans. This included supporting people who used a tube surgically placed in their stomach as they could not swallow food safely. Professionals told us they had no concerns regarding people’s nutritional support. One commented, “The documentation of the fluid and food intake is really good.” Relatives also spoke positively about people’s food and drink support and a relative told us, “If [the person] wants anything they can have it, a drink or a snack. They make sure [the person] eats healthily.” We saw staff help people to make choices about that they wanted to eat prepare food and drinks that people liked.

The staff worked well across teams and services to support people. This included with GPs, district nurses, pharmacists and other professionals. Professionals described how the staff and managers worked effectively with them to provide care to people. A professional told us, “If there is some issue, they always report to us immediately.” Professionals were involved in the assessment of people’s health and care needs. A professional commented that staff always provided them the information they needed to review people’s needs and provide their service. People had up to date Hospital Passports in place. These provided healthcare professionals with information about the person’s needs and preferences, in the event of someone having to go to hospital. A relative commented, “Any tiny sign of someone not being right and they get the GP straightaway and let you know.”

The service did not always responded promptly to risks that could affect people’s health. The service had not identified and responded promptly to hospital discharge information about safely supporting a person at risk of choking. People had health action plans (HAPs) in place. These set out important information about their health needs, the professionals involved to support those needs and information about hospital and other relevant appointments. The HAPs were mostly detailed but in some cases did not reflect all of a person’s health information, such as all the conditions they lived with. The service supported people to access external health and social care professionals. Staff and managers supported referrals to other services to promote meeting people’s healthcare needs. Staff supported people to attend health appointments, including unplanned visits to hospital and staff kept clear records of these. Professionals told us staff supported their appointments when they visited people at home. Staff had completed training on how to support people with their oral health. They supported people to have dentist visits at home to make their examinations more comfortable for them. Relatives we spoke with said the service supported people appropriately with their health.

The service monitored people’s care but this did not continuously improve people’s care experiences. The provider did not always ensure that people experienced person-centred outcomes that were planned with them. While people’s care plans set out personalised information such as their likes, dislikes and important routines, the plans lacked clear goals and aspirations to support people with, in line with good practice. Goals were limited to arranging a birthday party or helping a person to eat and drink and rather than promoting a person’s ambitions, skills or interests to improve their quality of life. Care plans emphasised the need for consistent approaches from staff to help them be safe. One person’s plan set out how to proactively support them when they may experience distress or agitation. The service monitored and reviewed people’s care.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. The service worked in line with the Mental Capacity Act 2005 (MCA). There were procedures in place for assessing people’s mental capacity to agree to their care or make other specific decisions when needed. Records indicated when people were assessed as lacking capacity to make a decision, this was made in their best interests. People’s relatives and where appropriate, relevant professionals were involved in making these decisions. The service also worked with a person’s independent advocate to help ensure the person’s wishes were taken into account when making decisions about their care. Staff supported people to make choices about their day to day care, such as what drinks they would like.